HB 7

1	A bill to be entitled
2	An act relating to coverage for mental and nervous
3	disorders; amending s. 627.668, F.S.; revising
4	requirements and limitations for optional coverage for
5	mental and nervous disorders; specifying nonapplication
6	under certain circumstances; amending s. 627.6675, F.S.;
7	conforming a cross-reference; repealing s. 627.669, F.S.,
8	relating to optional coverage required for substance abuse
9	impaired persons; providing for application; providing an
10	effective date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1.  Section 627.668, Florida Statutes, is amended
15	to read:
16	627.668  Optional coverage for mental and nervous disorders
17	required; exception.--
18	(1)  Every insurer, health maintenance organization, and
19	nonprofit hospital and medical service plan corporation
20	transacting group health insurance or providing prepaid health
21	care in this state shall make available to the policyholder as
22	part of the application, for an appropriate additional premium
23	under a group hospital and medical expense-incurred insurance
24	policy, under a group prepaid health care contract, and under a
25	group hospital and medical service plan contract, the benefits
26	or level of benefits specified in subsections subsection (2) and
27	(3) for the necessary care and treatment of mental and nervous
28	disorders, as defined in the most recent edition of the
29	Diagnostic and Statistical Manual of Mental Disorders published
30	by standard nomenclature of the American Psychiatric
31	Association, subject to the right of the applicant for a group
32	policy or contract to select any alternative benefits or level
33	of benefits as may be offered by the insurer, health maintenance
34	organization, or service plan corporation, provided that, if
35	alternate inpatient, outpatient, or partial hospitalization
36	benefits are selected, such benefits shall not be less than the
37	level of benefits required under subsections (2) and (3)
38	paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c),
39	respectively. With respect to the state group insurance program,
40	the term "policyholder" means the State of Florida.
41	(2)  Under group policies or contracts, inpatient hospital
42	benefits, partial hospitalization benefits, and outpatient
43	benefits consisting of durational limits, dollar amounts,
44	deductibles, and coinsurance factors shall not be less favorable
45	than for physical illness generally for the necessary care and
46	treatment of schizophrenia and psychotic disorders, mood
47	disorders, anxiety disorders, substance abuse disorders, eating
48	disorders, and childhood ADD/ADHD.
49	(3)(2)  Under group policies or contracts, inpatient
50	hospital benefits, partial hospitalization benefits, and
51	outpatient benefits for mental health disorders not listed in
52	subsection (2) consisting of durational limits, dollar amounts,
53	deductibles, and coinsurance factors shall not be less favorable
54	than for physical illness generally, except that:
55	(a)  Inpatient benefits may be limited to not less than 45
56	30 days per benefit year as defined in the policy or contract.
57	If inpatient hospital benefits are provided beyond 45 30 days
58	per benefit year, the durational limits, dollar amounts, and
59	coinsurance factors thereto need not be the same as applicable
60	to physical illness generally.
61	(b)  Outpatient benefits may be limited to 60 visits per
62	benefit year $1,000 for consultations with a licensed physician,
63	a psychologist licensed pursuant to chapter 490, a mental health
64	counselor licensed pursuant to chapter 491, a marriage and
65	family therapist licensed pursuant to chapter 491, and a
66	clinical social worker licensed pursuant to chapter 491. If
67	benefits are provided beyond the 60 visits $1,000 per benefit
68	year, the durational limits, dollar amounts, and coinsurance
69	factors thereof need not be the same as applicable to physical
70	illness generally.
71	(c)  Partial hospitalization benefits shall be provided
72	under the direction of a licensed physician. For purposes of
73	this part, the term "partial hospitalization services" is
74	defined as those services offered by a program accredited by the
75	Joint Commission on Accreditation of Hospitals (JCAH) or in
76	compliance with equivalent standards. Alcohol rehabilitation
77	programs accredited by the Joint Commission on Accreditation of
78	Hospitals or approved by the state and licensed drug abuse
79	rehabilitation programs shall also be qualified providers under
80	this section. In any benefit year, if partial hospitalization
81	services or a combination of inpatient and partial
82	hospitalization are utilized, the total benefits paid for all
83	such services shall not exceed the cost of 45 30 days of
84	inpatient hospitalization for psychiatric services, including
85	physician fees, which prevail in the community in which the
86	partial hospitalization services are rendered. If partial
87	hospitalization services benefits are provided beyond the limits
88	set forth in this paragraph, the durational limits, dollar
89	amounts, and coinsurance factors thereof need not be the same as
90	those applicable to physical illness generally.
91	(4)  In providing the benefits under this section, the
92	insurer or health maintenance organization may impose
93	appropriate financial incentives, peer review, utilization
94	requirements, and other methods used for the management of
95	benefits provided for other medical conditions, to reduce
96	service costs and utilization without compromising quality of
97	care.
98	(5)(3)  Insurers must maintain strict confidentiality
99	regarding psychiatric and psychotherapeutic records submitted to
100	an insurer for the purpose of reviewing a claim for benefits
101	payable under this section. These records submitted to an
102	insurer are subject to the limitations of s. 456.057, relating
103	to the furnishing of patient records.
104	(6)  This section does not apply with respect to a group
105	health plan, or health insurance coverage offered in connection
106	with a group health plan, if the application of this section to
107	such plan or coverage has caused an increase in the costs under
108	the plan or for such coverage of more than 2 percent, as
109	determined and certified by an independent actuary to the Office
110	of Insurance Regulation.
111	Section 2.  Paragraph (b) of subsection (8) of section
112	627.6675, Florida Statutes, is amended to read:
113	627.6675  Conversion on termination of
114	eligibility.--Subject to all of the provisions of this section,
115	a group policy delivered or issued for delivery in this state by
116	an insurer or nonprofit health care services plan that provides,
117	on an expense-incurred basis, hospital, surgical, or major
118	medical expense insurance, or any combination of these
119	coverages, shall provide that an employee or member whose
120	insurance under the group policy has been terminated for any
121	reason, including discontinuance of the group policy in its
122	entirety or with respect to an insured class, and who has been
123	continuously insured under the group policy, and under any group
124	policy providing similar benefits that the terminated group
125	policy replaced, for at least 3 months immediately prior to
126	termination, shall be entitled to have issued to him or her by
127	the insurer a policy or certificate of health insurance,
128	referred to in this section as a "converted policy." A group
129	insurer may meet the requirements of this section by contracting
130	with another insurer, authorized in this state, to issue an
131	individual converted policy, which policy has been approved by
132	the office under s. 627.410. An employee or member shall not be
133	entitled to a converted policy if termination of his or her
134	insurance under the group policy occurred because he or she
135	failed to pay any required contribution, or because any
136	discontinued group coverage was replaced by similar group
137	coverage within 31 days after discontinuance.
138	(8)  BENEFITS OFFERED.--
139	(b)  An insurer shall offer the benefits specified in s.
140	627.668 and the benefits specified in s. 627.669 if those
141	benefits were provided in the group plan.
142	Section 3.  Section 627.669, Florida Statutes, is repealed.
143	Section 4.  This act shall take effect January 1, 2011, and
144	shall apply to policies and contracts issued or renewed on or
145	after that date.

CODING: Words stricken are deletions; words underlined are additions.